Premium-insurance-policy blank.



G. E. DICKSON.

PREMIUM INSURANCE PoLlcY BLANK.

VAPPLICATION FILED JULY H), l9!2.

Patented Mar. 21,1916

@fam/14m x a02/a Amount Illlwuk ,UNITED *STATES MTE-NT OFFICE GEORGE E. DICKSON, F CHICAGO, ILLINOIS.

To all/whom it may concer-nr Be it known that I GEocE'E. Dickson', a citizen of the'U'nitcd States, andkaresidentof Chicago, Cook-icou'n'ty, Illinois, have invented' avcertain new, useful, and 'Improved Preinium-Tnsurance-Policy. Blank,

,ofwhich thegfolloivingis a specification.

v'illing tov spend' dise, that insur `My invention relates generally to Vtrade securing.premium'devices and'has special 110 reference to insurancev premium blanks.A

IA -vast number'fo'f merchants use one sort or 'another ofprei'niuni giving plan for the purposefof increasingthev sale of merchandise and also for i-ncreasingi,their patronage.l Such. plans consistgenerfallyfin"giving to the customers ticket of some kind on which the -value ot the purchase is marked, a certain number of which a-ieredecinable'either for cashoitfo'r an 4artic' lejof irierchandise. Such plans 'have proven" to -be excellenttradewinners and as a result-merchants are a -.'co'nsiderable sum1.' for such purpose. A "v. :i- Y The general ,objectief my invention. is to rovide premiumgiving means -Which-Willl'e 'greater .inducement Yto :the .purchase of merchandise than means hitherto devised.-

`. A-further.-objectcffiriy invention .isto provide an; improved trade f s'ecuriiig pre; v mium which, may bergused 'forthergeneral purpose above outlined. f

A further' object is t'oprovide premium insurance. blank or 'policy a-daptedffor use in giving insurance; asa. .premium .with the purchase ofmerchandise.

Another object offliy invention is to provide adevice which 'asa pfremiifim will induce 'small buyers? to maintain anA amount of life, accident, or. welfare insurancecommensurate-.xvith or proportioned: VtoV their average expenditures-,for groceries, meats,

clothing, and supplies I-havcworkedout a table'of insurance of such value,deteifniined the purchases would make of inerchanf which a. cust-0n i e companies according to their-tables #of l y ance at 'a cost which merchants ordinarily spend for premium purposes. l

lilly invention consists generally in a uniquepreinium`insurance'policy blank em liodyinpr theieatures outlined and adapted for use by merchants in giving insurance to their customers as a premium with the purchase of goods.

My invention consists further in an in- `Specification of Letters Patent.

whole being. easily-@div sible term po rtion,- and 4the` 'remainderftog orrecord portion.-

.PREMIUM-INSURANCE-POLICY BLANK.

Patented llar. 21, 1916. Y bpiication iiieci July is, i912` semi No. v710,24i. I

.surance policy bla-'nk of novel f orm and. ar;

rangement off-parts, certain of whichcarry `c onditi'on clauses Aand otherof which ea rry afable-fixing clauses, the. value .-ix-

ing clauses depending;A -for` their interpretainsurance policy blank comprising a fixedterm portion constituting th'epolicv proper, a stubY portion 'coI istit-iitin'p,r aA record ofthe insurers name, thev value and ni'imoer-Ml the policy, and an intermdiate portio;'eom' prising a plurality Aof'sep'a'iafblyfd etachable value determining;-portioiis, 1the:device-as a f is Y My Ainvention ,cons iSts-i:fuifther.'v inaarrangement of parts, and interdependence which will appear, are'at'tainedi y My invention will be more readilyunder- -of conditionson the. .-varibus portions, ythat the above named objects, :1s-.well asHot-hers stood by Vreference tothe accompanying i drawing which illustrates .one embodiment thereof.

times the ividth'. It comprises threernain port-ions, A, B, and C. The-portion A 001i-,-

tains the name'of the insurance company, date of issue, number of the-policy and one or more clauses fixing the terms, conditions, k can safely issue insurA andprovisions of the policy. For example,

suffered as a. result of bodily injury, vand article 3 a clause fixing the .maximum preioo v mium of theipolicyin any event. 'Itwvill i be seen 'that the clauses 1 and 2 in and of themselves fix the term of the policy subject to article 3, butthat the value of the policy must be determined by'reference to llO fore, be called .term'x'ingandvalue in` the portion' B. "These clauses may -thereter'preting' clauses and-the portion A .will

mark In the drawing, Ighaveindicated the herein be called the policy proper. I divide the portion B by a pluralityoftransversely vscored lines b into a plurality vof strips b.; `Each 'of these strips contains the words" Amount o purchase followed by a value value mark on'the stri-p nearest the portion A s l X-Dollar; on the next 'strip 2 X \.Do11ars; and so on ascending in value to the 'highest' amou'iit 10" X' Dollars 'onthe strips'` co/I'lt'iguousthe portion C'. It will beu'nderstood that X merelr represents a value unit which may be anything desired. vThese value marks asclearly shown by the words designate'the amount' of igoods' purchased-bythe 'custom'cn'and as'will be ex- .linesblsuch vas will leave upon the portion plained, 'the device as a whole is severed into two parts on one of thescored lines b. The portion B .willj 'be' vreferred to as the value determining portion.

. The portion' C contains the printed words Date .of issue, Name of purchaser,

Policy'nu'mber and several blank lines for insertionfof the date and name. The date of issue mayl beconveniently inserted by means of atrubber stamp, so that the only work necessary' in making out the policy is to write the name of the purchaser on the policy and tear itinto `tvvofparts on one-of the scoredv A, a strip'ccmtainingz'the'value of the purchase. Let 'us considera customer making a purchase 4of'ff) X` Dollarsf.- The blank as a whole is torn into `two'parts on the Vline b5.

The portion D is given tothe customer and Zlio 'the portionv E retained bythe merchant or sent/by-him to the' insurance company for' its records. Therefore the portion D indicates that the customer has made a purchase lamounting'to "5 X Dollars and the portion A thereof interprets thermeaning of the 5 X .Dollars, namely, if the insured 'suffers injury article l states that the assured Willbe given one-third of 5 X Dollars per 'month for a term not exceeding lthree months. If on theother hand, the assured suffers death, as 'a result of-injury by article '2, his executors, administrators, or assigns will be given 5 'X Dollars providing the 5 X Dollars .with such other insurance policies ofv this .nature .as the insured may have, do' not exceed an aggregate of one hundred and fifty ($150.00) dollars and providing the policy was not issued more' than ninety days before the accident according to article 3. Y l

The stub portion'E has a complete record of the policy since it has the date of issue, the name of the purchaser, number and the value as indicated by the strip b". The strip b contains a larger value than the policy, namely 6 X Dollars, butsince the strips .as this premium is a ascend in value in a certain'pre-determined ratio, the amount of the policy is` readily known. As indicated in 'the drawings itis l X Dollars less than the amount on the strip 5. y

' Not only does the value fixing portion so operate, but it also" operates-automatically to determine the'l amount of premium due from the merchant to the insurance company "There are numerous4 advantages of my premium insurance policy blank.- It appeals' strongly to the purchaser since it has a larg'v face value and virtually 'enables a 'person to fixed percentage (say maintain a -definiteamount' of insurance. For instance, if a persontrades constantly at 1a given store, notwithstanding -the ninety dayexpiration'clause,"the purchaser will 'all ways haveinsurance for' 'an.;am6unt equal.

to his average vexpenditures during4 the ninety days previous. Therefore, Yit operl'f ates automatically. to ixvthe amount of the` policy holders insurance at exactly the' amount requiredto cover the regular house7V hold expenditures for'articles. of daily use;

ample insurance is thus provided while o ver.-A

insurance is avoided.l It is thoroughly adapted to :the merchants needs a premium proposition Vbecause vof trade inducing character, because the clerical work necessary to itsissuance is little, 'and because the cost tothe merchant for such insurance A isssm'all.4 "Further the insurance ,companies are enabled-to sell muchinsurance which they could not otherwise sell and to sell the same at less-cost since t-he personal solicita- Patent:

los

described accomplishes the objects setforth 'for consignment to a .sellerV` by an insurer A and for issuancegby .the seller to fa purthe same time, operates' to record' the amount of the purchase and oorrespondinglyfixthe liabilit of the insurer to the 'purchaser and` also the liability of the cons igne'e seller to the insurer,- andco'mprising va 'single Asheet a seriesof narrow intermediate portioiis all` of the'full" width of 'the' sheet, one of said` end portions 'beingl printed to receive theA purchasers name and' the 'date-'of thetransaction, the other end .portion being larger and being printed with theins'urers policy 'contract including termsy whereby its value shall be' fixed by an intermediate portion and :115. v chaser and which when issued,' at one' and of lpaper composed of two end portions and requirin no signatures or names, and said interme iate portions being printed with vlue determining characters, increasing in order from the policy portion toward the name receivin portion and said intermedinte portions emg separated by lines extending the full width of the sheet, whereby said sheet may be readily divided into two parts, the larger part comprising the policy und the intermediate portion fixing the value thereof and the liability, to the pur- Chaser and insurer, respectively and the smaller Partixing the liability of the selier to the insurer, both parts recording the amount of the purchase and insomnie in testimony whereof? 1 have here set, my hand, this lth dny JulyT im the presence of two subscribing wiine Witnesses:

ARTHUR W. NELscN, JOHN R. LEFEVRE. 

